Toll-like receptors (TLRs), a large family consisting of at least 10 members, are evolutionarily conserved to recognize pathogen-associated molecular patterns (PAMPs). TLRs activation not only initiates innate immunity, but also regulates enhance antigen-specific acquired immunity, and thus associates innate and adaptive immunity. In recent years, studies on the TLRs signaling, especially their negative regulation, rapidly progressed. TLRs signaling pathway and their roles in regulating immune responses against invading pathogens were reviewed.

Objective To summarize experience to prevent the main postoperative complications after hypospadias repairs. Method The clinical data of 189 cases of hypospadias repairs was from May 2005 to August 2010,retrospectively analyzed. Results One hundred and seventy-four cases were surgically cured by single-stage operation. All cases had been followed up for 4-36 (18.5 ± 5.5) months, the cases who had become adults were normal penile development and erectile function. Postoperative complications occurred in 15 cases,9 cases of them were urethral fistulas,6 cases were urethral strictures,all were cured or improved after symptomatic treatments. Conclusions Some methods are necessary to raise single-stage urethroplasty success rate and decrease the incidence of fistulas and strictures, such as preoperative antibiotic prophylaxis,appropriate procedure,intraoperative suprapublic urinary diversion,the good blood supply of the flap, modified enswathement, postoperative manage and nursing.

BACKGROUND:O-arm navigation integrates CT image quality and the flexible mobility of the C-arm. Surgery for severe spinal deformity is very difficult, with high incidence of nerve injury, so it is a chalenging surgery for spinal surgery. The role of O-arm in the correction of spinal deformity is particularly important. OBJECTIVE:To explore the effect and safety of pedicle screw placement in severe spinal deformity under the guidance of O-arm navigation system. METHODS:Clinical data of 25 patients with severe spinal deformity with the aid of O-arm navigation were retrospectively analyzed. We observed pedicle screw insertion, operation time, intraoperative blood loss, correction of scoliosis and correction of kyphosis, and assessed the safety of screw insertion. RESULTS AND CONCLUSION:(1) Totaly 326 pedicle screws were implanted in 25 patients. According to NEO classification, 280 pedicle screws (92%) belonged to grade 0 (no perforation of pedicle cortex). Grade 1: perforation of pedicle cortex, < 2 mm, including 44 screws (8%); grade 2: perforation of pedicle cortex, > 2 mm, < 4 mm, including 0 screw (0%); grade 3: perforation of pedicle cortex, > 4 mm, including 0 screw (0%). (2) Operation time was (272.3±17.3) minutes. Intraoperative blood loss was (1 710.0±229.1) mL. (3) Cobb angle of scoliosis was changed from (70.5±6.0)° preoperatively to (22.8±4.8)° postoperatively. Cobb angle of kyphosis was changed from (72.0±5.2)° preoperatively to (28.1±5.7)° postoperatively. Significant differences were detected (P< 0.05). (4) These findings verify that with the guide of the O-arm navigation system, the accuracy of screw insertion is high. The risk of intraoperative nerve injury was reduced. The scoliosis and kyphosis deformity were improved effectively.

A total of 3499 cases of influenza A (H1N1) were included in this study for analysis.Epidemiological and clinical data of these cases were input into EpiData software and analyzed by SPSS software. Throat swabs were collected from the cases and detected for nucleic acid of influenza A ( H1N1 )virus using real-time polymerase chain reaction (RT-PCR) with fluorescence quantitative method, and time of viral excretion and clinical features of the cases were analyzed. Results showed that 0. 37% of the cases were in-apparent and asymptomatic and the most common symptom of the cases was fever (86. 77% ).Throat swabs converted to negative on the sixth day of onset in average, and no factors related to the time of conversion was found with logistic regression analysis.

OBJECTIVETo explore the variation and association of intestinal epithelial tight junctions, E.coli, and expression of Toll-like receptor-4 (TLR-4) and tumor necrosis factor-alpha (TNFα) in a rabbit model of non-alcoholic fatty liver disease (NAFLD).

METHODSFourteen male New Zealand rabbits were randomly divided into two groups. The control group was given a normal diet, while the NAFLD group was given a high-fat diet. After 12 weeks, the two groups were sacrificed. Both length and width of the tight junctions of ileum epithelial cells were measured by electron microscopy. Enzyme-linked immunosorbent assay was used to detect the concentration of TNFα in venous blood serum. Location and expression of TLR-4 were observed by immunohistochemical staining. Copies of E.coli genes were measured by RT-PCR. The relationship between TNFα and tight junctions, TLR-4, and E.coli were respectively analyzed by stepwise multiple linear regression.

RESULTSCompared with the control group, the NAFLD group has significantly shortened ileum epithelial fight junctions (t=5.031, P<0.01), increased copies of E. coli genes (t=-3.492, P<0.01), and increased ileal expression of TLR-4 (t=-44.089, P<0.01). A significant increase of TNFα was also observed in the NAFLD group (t=-17.768, P<0.01). Regression analysis showed that E.coli and intestinal epithelial tight junctions were correlated (standardized beta=-0.385), and showed a positive correlation between E. coli and TLR-4 (standardized beta=0.332 and 0.427).

CONCLUSIONDamage to the intestine as a physical barrier, biological barrier and immune barrier is closely related to TNFα expression, and the relation between the immune barrier and TNFα is more significant.

Animals ; Epithelial Cells ; Escherichia coli ; Intestinal Mucosa ; Male ; Non-alcoholic Fatty Liver Disease ; Rabbits ; Tight Junctions ; Toll-Like Receptor 4 ; Tumor Necrosis Factor-alpha

ObjectiveTo evaluate the effect of aminooxyacetic acid on focal cerebral ischemia injury in rats.MethodsEighty healthy male SD rats aged 2.5 month weighing 250-280 g were randomly divided into five groups( n ＝ 16 each):sham operation group(group S),cerebral ischemia group(group Ⅰ),aminooxoacetic acid low,medium and high dose groups(groups AL,AM and AH ).Focal cerebral ischemia was induced by occlusion of middle cerebral artery using a nylon thread with rounding tip which was inserted into right internal carotid artery in groups I,AL,AM and AH.Intraperitoneal amincoxoacetic acid 25,50 and 100 μmol/kg were administered at 3 h of ischemia in groups AL,AM and AH respectively,while equal volume of normal saline 1 ml/kg were injected in groups S and I.Neurological function was assessed and scored (0＝ no deficit,4＝ unable to move,unconscious) in 8 rats at 21 h after aminooxyacetic acid administration in each group.The animals were then sacrificed and the brains were removed for determination of the cystathionine beta-synthase (CBS) activities in cortex,hippocampus and striatum corpora.The other eight rats of each group were sacrificed at 21 h after amincoxoacetic acid administration for determination of the cerebral infarct volume.ResultsCompared with group S,the neurological deficit scores and the CBS activities in cortex and hippocampus were significantly increased,the infarct volumes were significantly enlarged in group Ⅰ ( P < 0.05).Compared with group Ⅰ,the neurological deficit scores and the CBS activities in cortex and hippocampus were significantly decreased,the cerebral infarct volumes were significantly reduced in groups AM and AH (P < 0.05).There was no significant difference in the above-mentioned variables between groups AL and Ⅰ.ConclusionAminooxoacetic acid can reduce focal cerebral ischemia injury by decreasing CBS activity and reducing H2 S production in rats.

Objective:To explore the pathological type and clinical symptoms of heterotopic gastric mucosa in upper esophagus (HGM).Methods:From December 2018 to August 2019, at the First Affiliated Hospital of Xinjiang Medical University, the patients with HGM, reflux esophagitis (RE), Barrett esophagus (BE) and chronic non-atrophic gastritis (CNAG), who underwent gastroscopy were selected. The pathological type of HGM including acid secretion, mucinous and mixed type. The differences in the symptoms among HGM, RE, BE, and CNAG, as well as the differences in the clinical symptoms of different pathological types of HGM were analyzed. Chi-square test and analysis of variance were used for statistical analysis.Results:There were 82, 104, 76, and 178 cases of HGM, RE, BE, and CNAG, respectively. The acid secretion, mucinous and mixed types of HGM were 22, 20 and 40 cases, respectively. The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat, swallowing discomfort, hoarseness, and cough of HGM patients were higher than those of RE patients (63.4%, 52/82 vs. 14.4%, 15/104; 58.5%, 48/82 vs. 14.4%, 15/104; 50.0%, 41/82 vs. 6.7%, 7/104; 43.9%, 36/82 vs. 12.5%, 13/104), while the incidence rates of gastroesophageal reflux symptoms acid reflux, heartburn and belching were lower than those of RE patients (34.1%, 28/82 vs. 61.5%, 64/104; 14.6%, 12/82 vs. 72.1%, 75/104; 34.1%, 28/82 vs. 67.3%, 70/104), and the differences were statistically significant ( χ2= 47.80, 39.80, 44.80, 23.30, 13.80, 60.90 and 20.20, all P<0.01). The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat, swallowing discomfort, hoarseness, and cough of HGM patients were higher than those of BE patients (63.4%, 52/82 vs. 22.4%, 17/76; 58.5%, 48/82 vs. 19.7%, 15/76; 50.0%, 41/82 vs. 9.2%, 7/76; 43.9%, 36/82 vs. 6.6%, 5/76), and the incidence rates of reflux symptoms acid reflux, heartburn, belching, and post-sternal burning sensation were lower than those of BE patients (34.1%, 28/82 vs. 61.8%, 47/76; 14.6%, 12/82 vs. 55.3%, 42/76; 34.1%, 28/82 vs. 65.8%, 50/76; 20.7%, 17/82 vs. 42.1%, 32/76), and the differences were statistically significant ( χ2=27.00, 24.80, 31.00, 28.60, 12.10, 28.90, 15.80 and 8.40, all P<0.01). The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat, swallowing discomfort, hoarseness and cough, gastroesophageal reflux symptoms acid reflux, heartburn, belching and post-sternal burning, and non-reflux symptoms digestion, bloating and abdominal pain of HGM patients were higher than those of CNAG patients (63.4%, 52/82 vs. 5.1%, 9/178; 58.5%, 48/82 vs. 3.9%, 7/178; 50.0%, 41/82 vs. 3.9%, 7/178; 43.9%, 36/82 vs. 4.5%, 8/178; 34.1%, 28/82 vs. 12.4%, 22/178; 14.6%, 12/82 vs. 2.8%, 5/178; 34.1%, 28/82 vs. 3.9%, 7/178; 20.7%, 17/82 vs. 11.2%, 20/178; 30.5%, 25/82 vs. 15.2%, 27/178; 32.9%, 27/82 vs. 14.6%, 26/178; 15.9%, 13/82 vs. 9.6%, 17/178), and the differences were statistically significant ( χ2=106.50, 100.40, 79.10, 62.00, 17.20, 4.10, 74.00, 12.80, 8.20, 11.60 and 2.20, all P<0.01). The incidence rates of pharyngeal reflux symptoms foreign body sensation, swallowing discomfort, and hoarseness of patients with acid secretion type of HGM were higher than those of mucinous type (72.7%, 16/22 vs. 35.0%, 7/20; 72.7%, 16/22 vs. 15.0%, 3/20; 50.0%, 11/22 vs. 20.0%, 4/20), and the differences were statistically significant ( χ2=6.00, 14.10 and 4.10, all P<0.01). The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat, swallowing discomfort, hoarseness, and cough of mixed type were higher than those of mucinous type (72.5%, 29/40 vs. 35.0%, 7/20; 72.5%, 29/40 vs. 15.0%, 3/20; 65.0%, 26/40 vs. 20.0%, 4/20; 62.5%, 25/40 vs. 15.0%, 3/20), and the differences were statistically significant ( χ2=7.80, 17.70, 10.80 and 12.10, all P<0.01). Conclusions:The pathological classification of HGM patients with clinical symptoms of pharyngeal reflux may be acid secretion type or mixed type, which can be treated with acid suppression drugs or argon plasma coagulation under gastroendoscopy.

Objective To investigate the effect of axial load test in Taylor spatial frame treatment of external fixation for tibia and fibula fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 36 patients with open fracture of tibia and fibula admitted to Tianjin Hospital from March 2015 to June 2017.There were 22 males and 14 females,aged 21-71 years[(46.1±14.2)years].All patients received Taylor spatial frame external fixation for tibia and fibula fracture within 1 week after injury.After operation,18 patients received axial load test(experiment group),and the other 18 did not(control group).When the value of axial load test was less than 5% in experiment group,the Taylor spatial frame was removed.The control group used traditional method to remove the Taylor spatial frame.Comparisons were made between the two groups in terms of treatment duration,total cost,re-fracture after Taylor spatial frame removal and incidence of stent-tract infection.Results All patients were followed up for 3-14 months with an average of 8.6 months.Compared with control group,the treatment duration[(36.17±11 .44)weeks vs.(44.50±9.16)weeks]and total cost[(93.7±7.9)thousand yuan vs.(120.1±10.6)thousand yuan]of experiment group were significantly lower(P＜0.05).In the experiment group,there was 0 patient with re-fracture and two patients with stent-tract infection,with the complication incidence of 11%,while there were two patients with re-fracture and three patients with stent-tract infection,with the complication incidence of 28% in the control group(P＞0.05).Conclusions After Taylor spatial frame external fixation for tibia and fibula fractures,regular axial load test can safely and timely guide the removal of Taylor spatial frame.It can reduce the treatment duration and cost compared with the traditional removal method,being safe and reliable.

Objective To evaluate smooth muscle protein of 22 kDa (SM22) in the diagnosis of acute intestinal ischemia.Methods 96 healthy adult SD rats were evenly divided into experimental group and control group,with each group subdivided into 6 subgroups,subject respectively to superior mesenteric artery ligation or sham operation.The venous blood samples were extracted from each group rats' right heart atO.5,1,2,4,8,12 h after the operation,for SM22 testing and small intestines tissues for direct immunofluorescence staining of SM22.Results The serum SM22 concentration reached a peak at 4 h (265 ± 15) mg/L,then gradually decreased (P ＜ 0.05).The I-FABP was mainly expressed in the epithelium of intestinal mucosa.During the 4 hours of intestinal ischemia,The number of SM22 positive particles did not change.After 4 hours,the number of SM22 positive granules had gradually decreased compared with the control group (all P ＜ 0.05).Conclusion SM22 mainly exists in the smooth muscle of intestinal,during the ischemic necrosis of the intestinal muscle layer SM22 leaks into blood stream,resulting in high serum levels of SM22 facilitating early diagnosis of acute intestinal ischemia.

Objective:In this study, we aimed to compare the short-term safety of two digestive tract reconstruction techniques, laparoscopic total abdominal overlap anastomosis and laparoscopic-assisted end-to-side anastomosis, following radical resection of Siewert Type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 139 patients who had undergone radical surgery for Siewert Type II esophagogastric junction adenocarcinoma. These included 89 patients treated at the First Affiliated Hospital of Air Force Medical University from November 2021 to July 2023, 36 patients treated at the First Affiliated Hospital of Xi'an Jiaotong University from December 2020 to June 2021, and 14 patients treated at the Yuncheng Central Hospital in Shanxi Province from September 2021 to November 2022. The group consisted of 107 men (77.0%) and 32 women (23.0%) of mean age 62.5±9.3 years. Forty-eight patients underwent laparoscopic total abdominal overlap anastomosis (overlap group), and 91 laparoscopic-assisted end-to-side anastomosis (end-to-side group). Clinical data, surgical information, pathological findings, postoperative recovery, and related complications were compared between the two groups.Results:There were no significant differences in general clinical data between the overlap and end-to-side anastomosis groups (all P>0.05), indicating comparability. There was no significant difference in operation time (267.2±60.1 minutes vs. 262.8±70.6 minutes, t=0.370, P=0.712). However, the intraoperative blood loss in the overlap group (100 [50, 100] mL) was significantly lower compared to the end-to-side group (100[50, 175] mL, Z=2.776, P=0.005). Compared to the end-to-side group, longer distances between the tumor and distal resection margin proximal(1.7±1.0 cm vs. 1.3±0.9 cm, t=2.487, P=0.014) and the tumor and distal resection margin (9.5±2.9 cm vs. 7.9±3.5 cm, t=2.667, P=0.009) were achieved in the overlap group. Compared with the end-to-side group, the overlap group achieved significantly earlier postoperative ambulation (1.0 [1.0, 2.0] days vs. 2.0 [1.0, 3.0] days, Z=3.117, P=0.002), earlier time to first drink (4.7±2.6 days vs. 6.2±3.0 days, t=2.851, P=0.005), and earlier time to first meal (6.0±2.7 days vs. 7.1±3.0 days, t=2.170, P=0.032). However, the hospitalization costs were higher in the overlap group (113, 105.5±37, 766.3) yuan vs. (97, 250.2±27, 746.9) yuan; this difference is significant ( t=2.818, P=0.006). There were no significant differences between the two groups in postoperative hospital stay, total number of lymph nodes cleared, or time to first postoperative flatus (all P>0.05). The incidence of surgery-related complications was 22.9%(11/48) in the overlap group and 19.8% (18/91) in the end-to-side group; this difference is not significant (χ2=0.187, P=0.831). Further comparison of complications using the Clavien-Dindo classification also showed no significant differences ( Z=0.406, P=0.685). Conclusions:Both laparoscopic total abdominal overlap anastomosis and laparoscopic-assisted end-to-side anastomosis are feasible for radical surgery for Siewert Type II esophagogastric junction adenocarcinoma. Laparoscopic total abdominal overlap anastomosis achieves longer proximal and distal resection margins and better postoperative recovery; however, end-to-side anastomosis is more cost-effective.